Physician Services—90%

Benefits are provided for services and supplies provided by a licensed physician covered under this plan. Licensed physicians covered under this plan are defined on pages 122-123.

Each patient is responsible for a $10 copayment when an office visit is billed. There is an additional $10 copayment for an office visit billed by a nonpreferred provider. These office visit copayments do not apply toward the $200 annual deductible or $2,300 annual coinsurance maximum. This provision applies to patients without Medicare.

Covered services include:

• Physician visits.
• An eye examination (including refraction) performed in conjunction with a medical condition such as diabetes, glaucoma or cataracts.
• Hearing exams by a physician or audiologist to determine the presence of an illness, injury or other hearing loss.
• Injectable legend drugs administered in a physician's office that are used to treat a covered condition.
• Chemotherapy, radium therapy and other radioactive-type therapies.
• Allergy testing up to an annual maximum of $600.
• Antigen and allergy vaccines or serums.